PAHO Director and CARICOM Secretary-General sign 2025-2029 Joint Subregional cooperation strategy to advance health and equity in the Caribbean

Cristina Mitchell

22 Jul 2025

Santo Domingo.- Although our bodies can naturally produce vitamin D through sun exposure, deficiency is surprisingly common—even in tropical countries such as the Dominican Republic. Despite the sunny climate, many people have low levels without realizing it.

What causes this deficiency? How can we detect it, and what are the consequences of not treating it in time?Dr. Alejandro Cambiaso, a specialist in Family and Preventive Medicine at Médico Express, answers these and other questions to help better understand this silent yet significant health condition.

Why is Vitamin D so important?

Vitamin D is a fat-soluble vitamin that functions like a regulatory hormone in many vital bodily processes. It is mainly produced in the skin after exposure to UVB rays from sunlight and is also obtained in smaller amounts through food or supplements.

The World Health Organization (WHO) and various scientific societies recognize its essential role in calcium and phosphorus absorption and metabolism, bone health maintenance, and the proper functioning of the immune, cardiovascular, muscular, and nervous systems. It’s also linked to the prevention of chronic diseases such as osteoporosis, respiratory infections, autoimmune disorders, type 2 diabetes, and certain types of cancer.

Why do so many people have a deficiency?

Globally, vitamin D deficiency is highly prevalent. According to the WHO and studies published in The Lancet and Endocrine Reviews, over one billion people have insufficient levels. The main causes include limited sun exposure (due to urban lifestyles, sunscreen use, or clothing), older age, obesity, darker skin (melanin reduces synthesis), digestive or kidney diseases that affect absorption or metabolism, and diets low in vitamin D-rich foods.

These factors explain why deficiency is common even in sun-rich countries like the Dominican Republic.

How can you tell if you have a deficiency?

Vitamin D deficiency can remain silent for a long time. When symptoms do appear, they may include:

• Fatigue, muscle weakness, and generalized pain

• Bone pain (especially in the back or legs)

• Increased susceptibility to respiratory infections

• Mood changes like irritability or depression

In children, signs include growth delays and bone deformities.Due to the vague nature of these symptoms, the only reliable way to confirm a deficiency is through a blood test measuring 25-hydroxyvitamin D levels.

What’s the recommended sun exposure for adults and children?

The WHO and the International Vitamin D Research Society recommend 10 to 30 minutes of direct sun exposure daily (without sunscreen), depending on skin type, age, latitude, and time of day.

• Light-skinned individuals: 10–20 minutes

• Dark-skinned individuals: up to 45 minutes

It’s advisable to expose areas like the forearms, legs, and face during safe hours (before 10 a.m. or after 3 p.m.). If staying outdoors longer, sunscreen should be applied to prevent UV damage.

What foods are natural sources of Vitamin D?

Top natural sources include:

• Fatty fish (salmon, tuna, sardines)

• Beef liver

• Egg yolks

• Mushrooms exposed to UV light

• Fortified products: milk, cereals, juices, and plant-based drinks

Still, diet typically provides only a limited amount, making a combination of sunlight, balanced nutrition, and, when needed, tailored supplementation the most effective approach.

Can you have low Vitamin D even with a healthy diet and sun exposure?

Yes. Many people have suboptimal levels despite healthy lifestyles due to factors like genetics, sunscreen use, poor intestinal absorption, liver or kidney dysfunction, or excessive storage in fat tissue (in cases of obesity). That’s why lab testing is essential—especially for individuals with risk factors, fracture history, autoimmune diseases, or low sun exposure.

What health risks can arise from untreated deficiency?

Chronic deficiency can lead to:

• Osteomalacia or osteoporosis in adults

• Rickets in children

• Higher risk of falls and fractures

• Weakened immune system

• Worsening of autoimmune diseases

• Possible links to high blood pressure, metabolic syndrome, and neurological issues

Recent studies also connect low vitamin D levels with increased severity in infections like COVID-19.

Are Vitamin D supplements reliable? How is the right dose determined?

Supplements are safe and effective when properly prescribed. The preferred form is vitamin D3 (cholecalciferol) due to its better absorption. Doses can be taken daily, weekly, or monthly. The correct dosage depends on the person’s blood levels, age, weight, medical conditions, and underlying health status. Therefore, supplementation should not begin without prior evaluation and should always be medically monitored.

Guidelines from the U.S. Institute of Medicine (IOM), the Endocrine Society, and the WHO recommend maintaining blood levels between 30 and 50 ng/mL for most adults.

New Delhi: Issuing a recent alert, the Undergraduate Medical Education Board (UGMEB) of the National Medical Commission (NMC) has warned Indian medical students against taking admission to undergraduate medical courses in some institutes in Belize and Uzbekistan.

The Apex medical commission has listed down four medical institutes, including (i) Central American Health and Sciences University, Belize, (ii) Columbus Central University, Belize, (iii) Washington University of Health and Sciences, Belize, and (iv) Chirchik Branch of Tashkent State Medical University, Uzbekistan.

This comes after the Indian Embassy in Mexico and the Eurasia Division of the Ministry of External Affairs highlighted serious concerns against these medical institutes regarding the lack of compliance with Indian medical education standards, inadequate or non-existent university campus infrastructure, poor quality of educational and clinical training facilities, instances of harassment of Indian students, excessive fees being charged, and denial of fee refunds upon withdrawal from the course.

Medical Dialogues had been reporting on the advisories issued by the NMC against students going abroad to pursue their dreams of becoming doctors. The Commission has time and again warned students that the quality of medical education in several institutes abroad does not meet the NMC standards.

In the recent alert, NMC referred to the Commission's notices dated 8th August 2023 and 22nd November 2024, wherein Indian students aspiring to obtain medical qualifications from foreign institutions and subsequently seeking registration to practice allopathy in India, were advised to ensure strict compliance with the Foreign Medical Graduate Licentiate (FMGL) Regulations, 2021, notified on 18.11.2021.

NMC had specifically cautioned the students that any deviation in respect to the (i) duration of the course, (ii) medium of instruction, (iii) syllabus and curriculum, (iv) clinical training, and (v) internship or clerkship arrangements may result in disqualification of the students from obtaining registration in India.

"Despite these advisories, it has been observed that Indian students continue to seek admission to foreign medical institutions which do not meet the required standards prescribed under FMGL Regulations, 2021," noted the Commission.

Accordingly, based on the communications received from the Indian Embassy in Mexico and the Eurasia Division of the Ministry of External Affairs and the advisories issued by the Embassies, the Commission advised students to avoid seeking admission to some specific medical institutes in Belize and one in Uzbekistan.

"Failure to follow this advisory may result in ineligibility for medical registration in India. Further, it is also advised that before seeking admission to any foreign medical institute or university, the prospective students and their parents are strongly advised to carefully read the Alert/Advisory uploaded on the National Medical Commission (NMC) website dated 19th May 2025. The advisory contains critical information regarding recognized institutions, eligibility criteria, and other important guidelines," warned the Commission. 

"All those students who are governed by FMGL Regulation, 2021 and undergo their studies in such institutes/universities; are advised that they may face disqualification from registration in India, due to non-compliance with the FMGL Regulations, 2021. The students need to consider and immediately evaluate, if their current university meets FMGL Regulations, 2021. Stay in touch with NMC updates in the dedicated website, consult the Indian Embassy of the concerned country for updates on recognition or blacklisting of institutions and immediately take corrective measure since FMGL Regulations are applied at the time of screening/registration," it further mentioned. 

To view the notice, click on the link below:

https://medicaldialogues.in/pdf_upload/nmc-alert-note-advisory-for-indian-students-seeking-admission-to-foreign-institutes-universities-for-undergraduate-medical-courses-295377.pdf

Also Read: NMC Warning for MBBS aspirants! Apex Council warns against Unauthorised Medical Colleges, non-compliant foreign programs

Here are the top medical news for the day:

Maternal RSV Vaccine Cuts Infant Hospitalizations by 72%: Study Finds

Vaccinating pregnant women against respiratory syncytial virus (RSV) has led to a significant drop in newborn hospital admissions for severe lung infections, according to a new study published in The Lancet Child and Adolescent Health.

RSV is a widespread virus that typically causes mild cold-like symptoms but can lead to serious conditions such as bronchiolitis in infants. It remains the leading infectious cause of baby hospitalisations in the UK and globally. Protection during early infancy is critical, especially as RSV can result in intensive care admissions for the youngest patients.

The research assessed the real-world effectiveness of the RSV vaccine during pregnancy. The team studied 537 babies admitted to hospitals across England and Scotland during the 2024-2025 RSV season. Of these, 391 tested positive for RSV. The analysis revealed that mothers of RSV-negative babies were more than twice as likely to have received the vaccine before delivery compared to mothers of RSV-positive babies 41% versus 19%.

Further findings showed that when the vaccine was administered more than 14 days before delivery, it provided a 72% reduction in hospital admissions. Even when given at any time before birth, the vaccine still conferred a 58% protective effect. Experts recommend vaccination from 28 weeks of pregnancy to ensure optimal transfer of protective antibodies to the baby, although the jab can be safely administered up to birth.

The study underscores the vaccine’s potential as a key public health tool in reducing the burden of RSV in infants.

Dr Thomas Williams, study lead from the University of Edinburgh’s Institute for Regeneration and Repair, and Paediatric Consultant at the Royal Hospital for Children and Young People in Edinburgh, said: “With the availability of an effective RSV vaccine shown to significantly reduce the risk of hospitalisation in young infants in the UK, there is an excellent opportunity for pregnant women to get vaccinated and protect themselves and their infants from RSV bronchiolitis this coming winter.”

Reference: Bivalent prefusion F vaccination in pregnancy and respiratory syncytial virus hospitalisation in infants in the UK: results of a multicentre, test-negative, case-control study, Williams, Thomas CMiddleton, Catriona M et al., The Lancet Child & Adolescent Health, Volume 0, Issue 0

Can High Blood Pressure During Pregnancy Shorten Breastfeeding Duration?

Women diagnosed with hypertensive disorders during pregnancy (HDP) are less likely to initiate or continue breastfeeding, potentially missing out on long-term heart health benefits, according to a new study published in JAMA Network Open.

Hypertensive disorders in pregnancy disproportionately impact non-Hispanic Black/African American and American Indian/Alaskan Native women, contributing to significant health inequities. Importantly, Hypertensive disorders in pregnancy also increase long-term risks for cardiovascular disease, stroke, and kidney disorders.

In this study, researchers from Yale School of Medicine analyzed data from the Centers for Disease Control and Prevention’s Pregnancy Risk Assessment Monitoring System (PRAMS), covering over 205,000 participants who gave birth between 2016 and 2021. The sample represented a weighted population of nearly 11 million women from 43 states, Washington D.C., and Puerto Rico. Hypertensive disorders in pregnancy was defined by self-reported high blood pressure, preeclampsia, or eclampsia before or during pregnancy. Breastfeeding initiation and duration were measured through postpartum survey responses.

The study found that women with hypertensive disorders in pregnancy had 11% higher odds of never breastfeeding. Among those who initiated, they were 17% more likely to stop early, with a median breastfeeding duration 17 weeks shorter than their counterparts without hypertensive disorders in pregnancy.

“This paper provides foundational knowledge on which to build future studies to understand how our health systems can best support those individuals with hypertension in reaching their personal infant feeding goals. As a system, we must do better about supporting women with hypertensive disorders in pregnancy in reaching whatever their infant feeding goal may be, particularly if it involves any amount of breastfeeding. Such support could promise long term improvements in health outcomes for many pregnant individuals and their infants, especially among communities with high risk of cardiometabolic disease and breastfeeding cessation,” said Deanna Nardella, an instructor of pediatrics and physician-scientist with Yale School of Medicine and first author of the study.

Reference: Nardella D, Canavan ME, Taylor SN, Sharifi M. Hypertensive Disorders of Pregnancy and Breastfeeding Among US Women. JAMA Netw Open. 2025;8(7):e2521902. doi:10.1001/jamanetworkopen.2025.21902

Heart Healthy Habits May Shield You from Cancer, Dementia, Diabetes and More: Study

Maintaining optimal cardiovascular health not only protects the heart but also improves overall physical and psychological well-being, according to a new study published in the Journal of the American Heart Association.

The study, conducted by Dr. Liliana Aguayo and colleagues at Emory’s Nell Hodgson Woodruff School of Nursing and Global Diabetes Research Center, analyzed data from nearly 500 peer-reviewed studies. It examined how adherence to the American Heart Association’s Life’s Simple 7™ and its updated Life’s Essential 8™, which now includes sleep affects long-term health outcomes beyond the cardiovascular system. These metrics include not smoking, healthy eating, regular physical activity, maintaining a healthy weight, and managing blood pressure, cholesterol, blood sugar, and sleep.

Key findings revealed that individuals who follow heart-healthy behaviors are more likely to retain brain, lung, vision, hearing, and muscle function as they age. They also have lower stress levels and cortisol, fewer chronic illnesses like cancer, Alzheimer’s, diabetes, and depression, and face reduced risk of adverse pregnancy outcomes and mobility issues.

Moreover, these individuals report a higher quality of life and lower healthcare costs due to decreased medical utilization and non-cardiovascular disease-related expenses.

The study highlights the wide-ranging benefits of even modest lifestyle changes. It calls for expanded research on underrepresented populations, including children and pregnant women, to better understand the broader impact of cardiovascular health.

“While we recently learned that heart-health and brain health are closely tied, in this review we found that almost every organ system and bodily function from head to toe benefit from a heart-healthy lifestyle,” said Aguayo, the study’s lead author.

Reference: JOUR Cardiovascular Health, 2010 to 2020: A Systematic Review of a Decade of Research on Life's Simple 7, Aguayo, Liliana, Cotoc, Crina et al., Journal of the American Heart Association

doi: 10.1161/JAHA.124.038566

Women diagnosed with hypertensive disorders during pregnancy (HDP) are less likely to initiate or continue breastfeeding, potentially missing out on long-term heart health benefits, according to a new study published in JAMA Network Open.

Hypertensive disorders in pregnancy disproportionately impact non-Hispanic Black/African American and American Indian/Alaskan Native women, contributing to significant health inequities. Importantly, Hypertensive disorders in pregnancy also increase long-term risks for cardiovascular disease, stroke, and kidney disorders.

In this study, researchers from Yale School of Medicine analyzed data from the Centers for Disease Control and Prevention’s Pregnancy Risk Assessment Monitoring System (PRAMS), covering over 205,000 participants who gave birth between 2016 and 2021. The sample represented a weighted population of nearly 11 million women from 43 states, Washington D.C., and Puerto Rico. Hypertensive disorders in pregnancy was defined by self-reported high blood pressure, preeclampsia, or eclampsia before or during pregnancy. Breastfeeding initiation and duration were measured through postpartum survey responses.

The study found that women with hypertensive disorders in pregnancy had 11% higher odds of never breastfeeding. Among those who initiated, they were 17% more likely to stop early, with a median breastfeeding duration 17 weeks shorter than their counterparts without hypertensive disorders in pregnancy.

“This paper provides foundational knowledge on which to build future studies to understand how our health systems can best support those individuals with hypertension in reaching their personal infant feeding goals. As a system, we must do better about supporting women with hypertensive disorders in pregnancy in reaching whatever their infant feeding goal may be, particularly if it involves any amount of breastfeeding. Such support could promise long term improvements in health outcomes for many pregnant individuals and their infants, especially among communities with high risk of cardiometabolic disease and breastfeeding cessation,” said Deanna Nardella, an instructor of pediatrics and physician-scientist with Yale School of Medicine and first author of the study.

Reference: Nardella D, Canavan ME, Taylor SN, Sharifi M. Hypertensive Disorders of Pregnancy and Breastfeeding Among US Women. JAMA Netw Open. 2025;8(7):e2521902. doi:10.1001/jamanetworkopen.2025.21902

Puerto Plata — The humanitarian mission “Continuing Promise 2025″ aboard the U.S. hospital ship USNS Comfort carried out a comprehensive medical operation this Saturday at the Professor Javier Martínez Arias Polytechnic in Puerto Plata, where more than 1,500 people received free care in various medical specialties.

The event was conducted by Comfort staff in conjunction with the Ministry of Public Health and the U.S. Embassy, providing services in general medicine, dentistry, optometry, women’s health, dermatology, pharmacy, and cardiovascular evaluation. Participants were also provided with medications, vitamins, corrective lenses, and school kits.

Captain Dan Reiher, deputy commander of the mission, explained that, in addition to the care provided on land, 35 surgeries were performed on board the ship, following a medical evaluation process that began on the first day of the mission.

“This visit included medical care, training, and veterinary assistance . We performed surgeries such as cataracts, hernias, and breast reductions. We also provided dental care, medications, and school supplies. It has been a very positive effort,” said the captain, who also confirmed that the ship will depart on Monday for its next destination: Costa Rica.

• The medical event was part of a broader agenda that also included, hours earlier, a beach cleanup on the Puerto Plata boardwalk in collaboration with the Clean Ocean Foundation, and an earthquake rescue drill with the participation of the Emergency Operations Center (COE), Civil Defense, the Red Cross, and specialized units of the Armed Forces.

The day’s agenda continued with first aid training for first responders at the Puerto Plata Air Base, veterinary assistance sessions, and a free concert in Central Park featuring the Comfort Crew’s band, Uncharted Waters.

About the Continuing Promise 2025 mission and the USNS Comfort

Continuing Promise 2025 is a U.S. Southern Command humanitarian mission, coordinated by the U.S. Embassy in the Dominican Republic, that aims to strengthen regional cooperation through free medical services, joint training, and community activities.

The USNS Comfort, one of the largest U.S. hospital ships in the world, has visited the Dominican Republic seven times. This time, it concentrated its operations in Puerto Plata before continuing its route to Costa Rica.

The mission combines healthcare, disaster response, cultural exchange, and support for vulnerable communities.